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An increased risk of suicide has been reported for psychiatric patients. In several world regions, an underlying psychiatric disorder is reported in up to 90% of people who die from suicide, though this rate seems to be considerably lower in low‐ and middle‐income countries. Major psychiatric conditions associated with suicidality are mood disorders, alcohol and substance use disorders, borderline personality disorder, and schizophrenia. Comorbidity between different disorders is frequently associated with a higher suicide risk. A history of suicide attempts, feelings of hopelessness, impulsivity and aggression, adverse childhood experiences, severe psychopathology, and somatic disorders are common risk factors for suicide among psychiatric patients. Stressful life events and interpersonal problems, including interpersonal violence, are often triggers. A comprehensive and repeated suicide risk assessment represents the first step for effective suicide prevention. Particular attention should be paid during and after hospitalization, with the first days and weeks after discharge representing the most critical period. Pharmacological treatment of mood disorders and schizophrenia has been shown to have an anti‐suicidal effect. A significant reduction of suicidal thoughts and behavior has been reported for cognitive behavioral therapy and dialectical behavior therapy. Brief interventions, including psychoeducation and follow‐ups, are associated with a decrease in suicide deaths. Further development of suicide prevention in psychiatric patients will require a better understanding of additional risk and protective factors, such as the role of a person's decision‐making capacity and social support, the role of spiritual and religious interventions, and the reduction of the treatment gap in mental health care. [ABSTRACT FROM AUTHOR]

Introduction: Suicide is a global mental health problem for people of all ages. While rates of suicide in children and adolescents are reported as lower than those in older populations worldwide, they represent the third leading cause of death in 15–19‐year‐olds. The rates are higher among boys than girls worldwide, though the death rates for girls exceed those for boys in Bangladesh, China, India, and Nepal. There has been a general decrease in adolescent suicide rates over recent decades. However, increases are reported in South East Asia as well as South America over the same time period. Methods: A narrative review method has been used to summarize current knowledge about risk and protective factors for suicide among children and adolescents and to discuss evidence‐based strategy for suicide prevention in this age group. Results: Identified suicide risk and protective factors for children and adolescents largely overlap with those for adults. Nevertheless, developmental characteristics may strengthen the impact of some factors, such as decision‐making style, coping strategies, family and peer relationships, and victimization. The implementation of evidence‐based suicide preventive strategies is needed. Restricting access to lethal means, school‐based awareness and skill training programs, and interventions delivered in clinical and community settings have been proven effective. The effectiveness of gatekeeper training and screening programs in reducing suicidal ideation and behavior is unproven but widely examined in selected settings. Discussion: Since most studies have been conducted in western countries, future research should assess the effectiveness of these promising strategies in different cultural contexts. The use of more rigorous study designs, the use of both short‐ and long‐term follow‐up evaluations, the larger inclusion of individuals belonging to vulnerable groups, the evaluation of online intervention, and the analysis of programs' cost‐effectiveness are also required. [ABSTRACT FROM AUTHOR]

Background: Predictions of two different models for suicide attempts (SA) over 12 months, as differentially impacted by specific school‐based suicide prevention interventions, were compared. These were as follows: (a) interpersonal theory (IPTS) and (b) a two‐pathway model, one path associated with externalizing symptoms and continuum of self‐harm behaviors, and the other with internalizing symptoms. Methods: Self‐report questionnaires were completed by 11,110 high school students from ten EU countries enrolled in the Saving and Empowering Young Lives in Europe (SEYLE) study. Baseline measures included perceived burdensomeness, thwarted belongingness from parents and peers, health risk behaviors, self‐injury, suicide ideation (SI), and attempts (SA). SI and SA were reassessed at 12‐month follow‐up. Each model's predictions of SI and SA groups over time (i.e., repeated SA, remitted SA, SA onset, and no SA) were estimated in the no intervention/control group. The superior model was estimated across intervention groups. Results: Interpersonal theory showed better fit compared to the two‐pathway model. In partial agreement with IPTS predictions, parental low belongingness but not peer belongingness or burdensomeness predicted greater likelihood of SI. The likelihood of repeated SA versus no SA was higher among adolescents who reported SI, self‐injury, risk behaviors, and particularly both SI and self‐injury. All three interventions attenuated the combined effect of SI and self‐injury. Youth Aware of Mental Health Program (YAM) additionally decreased the effect of risk behaviors on the likelihood of repeated SA. Conclusions: Interpersonal theory assumptions were partially supported. Perceived interpersonal difficulties with parents were primarily related with SI, and risk behaviors and self‐injury were important predictors of SA. Suicide prevention interventions may be effective by mitigating the hazardous effect of varying self‐harm behaviors and may be further advanced by increasing parental involvement. [ABSTRACT FROM AUTHOR]

Objective: Suicide attempt (SA) is recognized as one of the risk factors for completed suicides. The concealment of this behavior often hinders detection and management of suicide risk. Thus, in this study, we sought to shed light on adolescents' psychosocial processes that could facilitate disclosure of SAs. Specifically, we sought to identify antecedents of adolescent SAs that had not been revealed to significant others.Method: A high school sample) N = 990 (completed a self-report questionnaire tapping psychiatric, personal, and interpersonal characteristics, as well as suicidality, as part of the SEYLE project. Twenty-seven adolescents acknowledged having made an SA without disclosing it to parents or to other significant others. They were compared with 47 adolescents who made SAs that were communicated to others and with a control group of 916 adolescents having no history of suicidal behavior.Results: Compared with disclosures and controls, non-disclosing suicide attempters were characterized by higher levels of suicide ideation, distress, and victimization. Low levels of self-disclosure and parental support were significantly associated with undisclosed SAs.Conclusions: Interpersonal difficulties may be related to loneliness and a thwarted sense of belongingness, which may explain the failure to disclose SAs. Implications related to assessment and prevention are discussed. [ABSTRACT FROM AUTHOR]

Background: The association between bullying victimization and depression, suicide ideation and suicide attempts has been studied mainly in cross‐sectional studies. This study aims to test the bidirectional effect and the chronicity versus sporadic effect of physical, verbal, and relational bullying victimization on suicidal ideation/attempts and depression. Methods: Longitudinal assessments with an interval of 3‐ and 12‐months were performed within a sample of 2,933 adolescents (56.1% females; mean age 14.78, SD = .89) from 10 European countries, participating in the Saving and Empowering Young Lives in Europe (SEYLE) school‐based multicenter control sample. Multilevel Structural Equation Models were used, controlling for sociodemographic variables. Victimization was considered chronic when a student was victimized in the first two time points and sporadic when it was reported only at one point but not in another. Results: Bidirectional prospective association between all types of victimization and depression were found. Among participants, who reported victimization once (but not twice), physical victimization, but not verbal and relational, was associated with later suicidal ideation and attempts. Chronic victimization of any type increased likelihood for later depression compared with sporadic and no‐victimization. Chronic relational victimization increased the likelihood of later suicidal ideation, and chronic physical victimization increased the likelihood for suicidal attempts. Conclusions: The results support the bidirectional effect of victimization and depression and indicate that there are complex longitudinal associations between victimization and suicidal ideation/attempts. Physical victimization may especially carry effect on suicidal risk over time. Interventions should focus on victimization as a cause of distress but also aim to prevent vulnerable adolescents from becoming targets of victimization. [ABSTRACT FROM AUTHOR]

Objectives To investigate the prevalence and associated psychosocial factors of occasional and repetitive direct self-injurious behavior (D- SIB), such as self-cutting, -burning, -biting, -hitting, and skin damage by other methods, in representative adolescent samples from 11 European countries. Methods Cross-sectional assessment of adolescents was performed within the European Union funded project, Saving and Empowering Young Lives in Europe ( SEYLE), which was conducted in 11 European countries. The representative sample comprised 12,068 adolescents (F/M: 6,717/5,351; mean age: 14.9 ± 0.89) recruited from randomly selected schools. Frequency of D- SIB was assessed by a modified 6-item questionnaire based on previously used versions of the Deliberate Self-Harm Inventory ( DSHI). In addition, a broad range of demographic, social, and psychological factors was assessed. Results Overall lifetime prevalence of D- SIB was 27.6%; 19.7% reported occasional D- SIB and 7.8% repetitive D- SIB. Lifetime prevalence ranged from 17.1% to 38.6% across countries. Estonia, France, Germany, and Israel had the highest lifetime rates of D- SIB, while students from Hungary, Ireland, and Italy reported low rates. Suicidality as well as anxiety and depressive symptoms had the highest odds ratios for both occasional and repetitive D- SIB. There was a strong association of D- SIB with both psychopathology and risk-behaviors, including family related neglect and peer-related rejection/victimization. Associations between psychosocial variables and D- SIB were strongly influenced by both gender and country. Only a minor proportion of the adolescents who reported D- SIB ever received medical treatment. Conclusion These results suggest high lifetime prevalence of D- SIB in European adolescents. Prevalence as well as psychosocial correlates seems to be significantly influenced by both gender and country. These results support the need for a multidimensional approach to better understand the development of SIB and facilitate culturally adapted prevention/intervention. [ABSTRACT FROM AUTHOR]

Background: Subthreshold-depression and anxiety have been associated with significant impairments in adults. This study investigates the characteristics of adolescent subthreshold-depression and anxiety with a focus on suicidality, using both categorical and dimensional diagnostic models. Methods: Data were drawn from the Saving and Empowering Young Lives in Europe (SEYLE) study, comprising 12,395 adolescents from 11 countries. Based on self-report, including Beck Depression Inventory-II (BDI-II), Zung Self-Rating Anxiety Scale (SAS), Strengths and Difficulties Questionnaire (SDQ) and Paykel Suicide Scale (PSS) were administered to students. Based on BDI-II, adolescents were divided into three groups: nondepressed, subthreshold-depressed and depressed; based on the SAS, they were divided into nonanxiety, subthreshold-anxiety and anxiety groups. Analyses of Covariance were conducted on SDQ scores to explore psychopathology of the defined groups. Logistic regression analyses were conducted to explore the relationships between functional impairments, suicidality and subthreshold and full syndromes. Results: Thirty-two percent of the adolescents were subthreshold-anxious and 5.8% anxious, 29.2% subthreshold-depressed and 10.5% depressed, with high comorbidity. Mean scores of SDQ of subthreshold-depressed/anxious were significantly higher than the mean scores of the nondepressed/nonanxious groups and significantly lower than those of the depressed/anxious groups. Both subthreshold and threshold-anxiety and depression were related to functional impairment and suicidality. Conclusions: Subthreshold-depression and subthreshold-anxiety are associated with an increased burden of disease and suicide risk. These results highlight the importance of early identification of adolescent subthreshold-depression and anxiety to minimize suicide. Incorporating these subthreshold disorders into a diagnosis could provide a bridge between categorical and dimensional diagnostic models. [ABSTRACT FROM AUTHOR]

Aims To investigate the prevalence of pathological internet use ( PIU) and maladaptive internet use ( MIU) among adolescents in 11 European countries in relation to demographic, social factors and internet accessibility. Design Cross-sectional survey. Setting The 7th Framework European Union ( EU) funded project, Saving and Empowering Young Lives in Europe ( SEYLE), is a randomized controlled trial ( RCT) evaluating interventions for risk behaviours among adolescents in Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain, with Sweden serving as the coordinating centre. Participants A total of 11 956 adolescents (female/male: 6731/5225; mean age: 14.9 ± 0.89) recruited from randomly selected schools within the 11 study sites. Measurements Internet users were classified by gender into three categories: adaptive, maladaptive and pathological, based on their score in the Young Diagnostic Questionnaire for Internet Addiction ( YDQ). Findings The overall prevalence of PIU was 4.4%; it was higher among males than females (5.2% versus 3.8%) and differed between countries (χ2 = 309.98; d.f. = 20; P < 0.001). PIU correlated significantly with mean hours online and male gender. The highest-ranked online activities were watching videos, frequenting chatrooms and social networking; significantly higher rates of playing single-user games were found in males and social networking in females. Living in metropolitan areas was associated with PIU. Students not living with a biological parent, low parental involvement and parental unemployment showed the highest relative risks of both MIU and PIU. Conclusions Across a range of countries in Europe, using the Young Diagnostic Questionnaire for Internet Addiction yields a prevalence of 'pathological internet use' of 4.4% among adolescents, but varies by country and gender; adolescents lacking emotional and psychological support are at highest risk. [ABSTRACT FROM AUTHOR]

We wished to examine determinants of suicidal behavior in prisoners. 903 male prisoners had a psychiatric interview which included various psychometric tests. Suicide attempters were compared with prisoners who had never attempted suicide. Significantly more of the attempters had a history of psychiatric disorder, substance abuse, a family history of suicidal behavior, convictions for violent crime, had exhibited aggressive behavior in jail, and had higher BGLHA aggression scores. A similar pattern of risk factors was found for prisoners with suicidal ideation. A lifetime history of attempting suicide, or of having suicidal ideation, is frequent in prisoners. Risk factors include family, developmental, aggression, personality psychiatric, and substance abuse factors. [ABSTRACT FROM AUTHOR]

The insertion deletion (ins/del) polymorphism of the serotonin transporter gene (5-HTTLPR) has been associated with several psychiatric phenotypes and antidepressant's response. We investigated, in a large cohort of 5,608 controls and subjects suffering from various psychiatric disorders, the frequency of haplotypes and corresponding genotypes combining the 5-HTTLPR and the other serotonin transporter promoter functional variant (rs25531). We showed that rs25531 lies 18 bp 5' to the site where the 43 bp (and not 44 bp as previously described) ins/del defines the 14- and 16-repeat alleles. These polymorphisms should therefore be considered as four alleles instead of a triallelic unique locus. The very rare G-14/G-16 genotype was carried on by only three subjects. These are women with a history of suicide attempt with a psychiatric history strongly suggesting a borderline personality disorder. Two of them have shown a non-response to serotoninergic antidepressant. Interestingly, in one of them was observed a spectacular response after the introduction of bupropion. The genotyping droved our therapeutic approach, by preferring a dopaminergic over a serotoninergic agent. This study highlights the usefulness of studying very rare clinical cases as well as rare variants, in order to deal with the biological heterogeneity of spectral disorders. © 2010 Wiley-Liss, Inc.